HomeMy WebLinkAbout02200 •
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 2 0 0
109 8th Street Suite 303 Assessor's Parcel No. S
Glenwood Springs, Colorado 91801
Phone (303) 945-8212 t t
This does not constitute 14
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY 4
Owner's Name John Uohneon Present Address 200 W. 20th, Rifle Phone_ 625 - 4928 i
System Location 11001 County Road 320, Rifle 6
Legal :Description of Assessor's Parcel No.
SYSTEM DESIGN f
1-. 0 Septic Tank Capacity (gallon) Other �yr
, r, 4 (i' r i t -e) e.
,, Percolation Rate (minutes/inch) �/ Number of Bedrooms (or other) / ( y / :. , /
2. 7� r' /) r: L 1A, -i- i c ft G l ' 13 ( / — / I v /� 7 x F-ir
Required Absorption Area - See Attache � ,r,- � -• (:{ ' 2 -- A , Et ) if .4 I o it t.trf ,..s ti- i'. YI 4:4 .16 f / {• c- E 5 it
F (-' G7 co �, 1k c 10 r ' r ✓ (r h . .Lai, 11 -f
Special Setback Requirements: 7_. �(
Date .y,..-- / 6/ Inspector s 1 (t t r'n`.'Q
8
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
F
Call for Inspection (24 hours notice) Before Covering Installation I mm
System lnsleller_l W' - k ^� I -� - - c � r , / > -,,. t
C ZSZ� v% L� 'Wn n, nYY ,i��/�' -e C .or, yy
2 ;i r -
Septi Tank Capacity /I 2 s 0 <�y , yi'!r- '- V.,wt i 0 ' �CLo C,1`j x . c
Septic Tank Manufacturer or Trade Name 9 _'.-
• r
• Septic Tank Access within 8" of surface ' >!------'^ k
Absorption Area .Q P A - +.+ r'a r4 .V 0
Absorption Area Type and /or Manufacturer or Trade Name ` '-i li ; Z^ a"'' n
I co
i Adequate compliance with County and State regulations /requirements 1
H
t
Other '
1 f
Date 2 `/O ' 9 e)
Inspector , Yry (% ' CA "C4
4 RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE r
*CONDITIONS: •
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter +.
25, Article 10 C.R.S. 1973, Revised 1984.
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- 11
?k
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a
requirement of the permit and cause for both legal action and revocation of the permit. !!'
3. Any person who constructs, alters, or installs an Individual sewage disposal system in a manner which involves a knowing and material
variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine — 8
months in )ail or both).
Applicant: Green Copy Department: Pink Copy
13 .�� f 1il ri
r . Application
INDIVIDUAL SEWAGE DISPOSAL S Ell WAWA Approval by
OWNER J 1 �0 � _ _ _ _ -- -/—=•> Coon ly 01 f is la I :
— i iFiEtD- COUNTY 1 � s �
ADDRESS 1100t C'" 24? 520 Q ►at.e 'IIONE (etc '4325 M/S22 eg
COIITRACTUi1 kas--sciotoarac.
ADDRESS Pil011E
PERMIT REQUEST FOR: ().4 Hew Installation ( ) Alteration ( ) Repair — — --
Attach separate sheets or report showing entire area with respect to surrounding areas,
topography of area, habitable building, location of potable water wells, soil percolation
test holes, soil profiles in test holes. (See page 4.)
LOCATION OF PROPOSED FACILITY: County ICL.Q__
Near what City of Tovin p.4..E _--- ^_ - -_ -- Lot Size _ 2,2/•eOE
Legal Description_ € 0e4A A3EM. Ea_Za — Rq ,u. =YIDS
1IO C.orovar.) Qo �2.a — -- — WASTES TYPE: (X) Dwelling ( ) 1ransleni Use
( ) Commercial or Institutional ( ) Hon-domestic Wastes
( ) Oilier - Describe -- - - -- - - - - - -- — _ --
BUILDING OR SERVICE TYPE:
1 her obyd o — Number of persons S _ --- _ --- -`
(� Garbage grinder (C) Automatic washer (� Dishwasher
RD AND TYI'L OF WATLR SUI'I'LY: .( ) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of systems 14q ' _ _ _ _..— —
If supplied by connuunity water, give name or supplier:1dr.( — a!F_eLFL!
GIlOUND CONDITIONS:
Depth to bedrock: ' • Depth to f i r s t Ground Water Table : — _ _-------_
I'ercent ground slope: _— ..r - - - -- - - - - - -- --
DISTANCE 10 NEAREST COMMUNITY SLWL SYSTEM: __ --- __._ __— _—_________
Was an effort made to connect to community system?_± ._
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM Pl1Ol'OSLI):
Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:___ ' —___,
FILIAL DISPOSAL BY:
( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filler
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe: IL _qeµ Agt..0 - - -- WILL EFFLUENT BE DISCHARGED DIRECTLY 11110 WATERS OF THE SiAIE7__0 -
, 1
LUa ..
iSU1L PEIICOLATI011 TEST RESULTS: (lo be completed by Registered Professional Engineer.)
Minutes per inch in hole No. 1 Minutes _ per inch in hole No. 3
(Minutes ' per inch in hole llo. 2 Minutes _ per Inch in (role No.
Name, address and telephone of ItI'C who made soil absorption tests:
Name, address and telephone of RPE responsible for design of the system:
Applicant acknowledges that the completeness of the application is conditional upon such
further mandatory and additional tests and reports as may be required by the local health
department to be made and furnished by the applicant or by the local health department for
purposes of the evaluation of the application; and the Issuance or the per•riri't.is'subject to
such terms and conditions as deemed necessary to insure compliance with rules and regulations
adopted under Article 1U, Title 25, C.R.S. 1973, as amended. 1he undersigned hereby certifies
that all statements made, information and reports submitted herewith and required lo be
submitted by the applicant are or will be represented lo be true and correct to the best
of my knowledge and belief and are designed to be relied on by the local. department of health
in evaluating the sauce for purposes of issuing the permit applied for herein. • 1 further under-
stand that any falsification or misrepresentation may result in the decrial of the application
or revocation of any permit granted based upon said application • d in legal action for per -
jury as provided by law. .
•
Date • 1112 \Qt Signed ,1 .
PLEASE DRAW AND ACCURATE MAI' 10 YOUR PROPERLY
ce A rrArt1*eQ
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Page 3
•
•
PLAT PLAN AND DESIGN TENURES:
Include by measured distance location of wells, springs, potable water supply
lines, cisterns, buildings, property lines, subsoil drains, lake, water course,
stream, dry gulch and show location of proposed system by direction and distance
from dwelling or other fixed reference object, and additional submissions in
support of this application such as data, plans, specifications, statements and '
commitments.
•
•
•
•
•
Page 4
ea
0 o ;v_
{F (7,) F ry xi r
Vl y 11 rr 7 '0
N R" N 0 °
p f O n 0 co I co
3 ° p/ „10,81.50 N I 0
I. I I *AP
iii: I N p
0 1.9,..•••• 6% I I I f L 2 0 `..
W - I
Pp
y - g.,\ •
vni � i o /
• N P
g
y • t I. U IS 11 '
Er 4.0 � - ---L -" 6 1
' 0
• � oc 3, 4 1 t Th.
— m
r \ I. I CI 0
1• • 1 rri m
y • 1 1 I I ■ ss
I I � . m i
F • ), . I' • I m m
g I I Z
• 0 r --1Ap R p a
0 11 11 11 11 b N I s pit
II co W 0 0 N0 \ O I 1 �� `n Cater_ r
W N ?N ON \ O 1• S I \ � Ol 0
O) O) • J DD R 0
A W J 0. in • • (n Z. i t W I - � `/
N A W E� 1
:� 2139 \\. g N ." 1 -1
1, I 1 Z 0 s / I
�A . \ / I C)
�' L m
fil
� / I _ -1
G I • I . I g N -
Z L 11 I
�r
$ g° /
o �$ o g m
N F \ ; I m
o
W °,
Pi
°'�
,.
v o u N1I 1
q
En
Lt ll I
4.•
O
,0
ri P 1 -$ I 1 I 3 .64 S v m s 5 R' N
8 w rtR• — 1 i o\
co Ro a�� Z oo a 3
: g F ain mizn �'�
OC 0 v L pl ° 3!5
rno £ ZP 94 A °
V mg co
I%) 3 N No v
0) 0 ` n(0
•O 0 X
S
IMPROVEMENT LOCATION CERTIFICATE
Metes and Bounds Parcel
Garfield County Road 320
Rifle, Colorado 81650
LEGAL DESCRIPTION
A tract of land situated in the SE1 /4 NE1 /4 of Section 20, Township 6 South,
Range 93 West of the Sixth Principal Meridian, County of Garfield, State of
Colorado: said tract being more particularly described as follows:
Commencing at the East Quarter Corner of said Section 20, a brass cap found in
place and properly marked;
thence N. 23 03'28" W. 1114.56 feet to a point on the northerly line of a 60.00
foot right -of -way for County Road No. 320, the true point of beginning;
thence leaving said northerly right -of -way N. 05 W. 291.72 feet to a point
on the northerly line of said SE1 /4 NE1 /4 of Section 20;
thence N. 89`30'57" E. along said northerly line 448.42 feet to the northeast
corner of said SE1 /4 NE1 /4 of Section 20;
thence S. 00 38'49" E. along the easterly line of said SE1 /4 NE1 /4 of Section 20,
176.40 feet to a point on said northerly right -of -way for County Road No. 320;
thence leaving said easterly line S. 78 34'13" W. along said northerly
right -of -way 75.74 feet;
thence along said northerly right -of -way along the arc of a curve to the left
having a radius of 2098.54 feet, and a central angle of 09`57'23 ", a distance of
364.67 feet (chord bears S. 73`35'31" W. 364.21 feet) to the true point of
beginning.
* * * * * * * * * * * * * * * * * * * *
I hereby certify that this Improvement Location Certificate was prepared for John
T. Johnson; that it is not a land survey plat or improvement survey plat; and
that it is not to be relied upon for the establishment of fence, building or
other future improvement lines.
I further certify that the improvements on the above described parcel, as of
December 9, 1993, except utility connections, are entirely within the boundaries
of the parcel, except as shown; that there are no encroachments upon the
described premises by improvements on any adjoining premises, except as
indicated; and that there is no apparent evidence or sign of any easement
crossing or burdening any part of said parcel, except as noted.
Based on FEMA mapping (Community Panel Number 085078 1353 D), subject property is
in Zone C.
Note: There was no final title policy available for this survey, so there may be
easements or rights -of -way of record other than what is shown on this
certificate. This certificate is based on Title Commitment Order No. GW1537
prepared by Land Title Guarantee Company dated December 21, 1992.
Notice: According to Colorado law, you must commence any legal action based upon
any defect in this certificate within three years after you first discover such
defect. In no event may any action based upon any defect in this certificate be
commenced more than ten years from the date of certification shown hereon.
Date: � 6 ¢c�» r /� / ?J . ( a : .
Herbert A. 'i char., P. - . 6826
3 6826 A.
oy )
9 , r ...... COVI QP'
Job No. 93 -148 Starbuck Surveyors and"Engineers
Page 2 of 2 P.O. Box 1584, Eagle, Colorado 81631
(303) 328 -7208 Eagle; (303) 625 -3913 Rifle